A 22 year old man admitted to intensive care with hyperthermia and seizures.

CASE REPORT A 22 year old man was admitted to the intensive care unit following ingestion of an unknown amount of alcohol and 3,4 methylene dioxymethamphetamine (‘ecstasy’). In the accident and emergency department he began to have seizures and was promptly intubated with an 8.0 mm endotracheal tube, 10 mg of midazolam and 8 mg of vecuronium, and mechanically ventilated. His vital signs revealed sinus tachycardia with a pulse rate of 170 beats per minute, a blood pressure 90/50 mmHg and a temperature of 41.1°C. The patient was admitted to the intensive care unit and a venovenous extracoproreal circulation was established to allow direct circulatory cooling. He remained sedated with intravenous morphine (2 mg/hr), midazolam (2 mg/hr) and a 1% propofol infusion. The plasma biochemical profile performed immediately on arrival (9.11) is shown in figure 1. Following 4 hours of extracoporeal cooling his vital signs improved with his pulse slowing to 118 beats per minute, blood pressure increasing to 115/60 mmHg and temperature decreasing to 36.5°C. However, throughout the next 5 days he remained mechanically ventilated, requiring intermittent vecuronium, morphine, midazolam and propofol as he became agitated and hypoxic when these agents were withdrawn. The plasma biochemical profile performed on the fifth day following admission (14.11) is also shown in figure1.